ORIGINAL ARTICLE – THORACIC
Interactive CardioVascular and Thoracic Surgery 21 (2015) 637–643 doi:10.1093/icvts/ivv223 Advance Access publication 12 August 2015
Cite this article as: Kawashima M, Murakawa T, Shinozaki T, Ichinose J, Hino H, Konoeda C et al. Significance of the Glasgow Prognostic Score as a prognostic indicator for lung cancer surgery. Interact CardioVasc Thorac Surg 2015;21:637–43.
Mitsuaki Kawashimaa, Tomohiro Murakawaa,*, Tomohiro Shinozakib, Junji Ichinosea, Haruaki Hinoa, Chihiro Konoedaa, Takehiro Tsuchiyaa, Tomonori Murayamaa, Kazuhiro Nagayamaa, Jun-ichi Nitadoria, Masaki Anrakua and Jun Nakajimaa a b
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
* Corresponding author. Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Tel: +81-3-38155411; fax: +81-3-56843989; e-mail:
[email protected] (T. Murakawa). Received 10 April 2015; received in revised form 30 June 2015; accepted 10 July 2015
Abstract OBJECTIVES: The Glasgow Prognostic Score (GPS), which is calculated with C-reactive protein (CRP) and albumin (Alb) values, is a prognostic indicator for various types of cancers. However, its role in lung cancer still remains unclear, and its optimal cut-off values are controversial. Here, we evaluated the significance of the GPS and adjusted GPS (a-GPS) using our institution’s cut-off values in patients undergoing resection for primary lung cancer. METHODS: We analysed 1043 lung cancer patients who underwent resection between 1998 and 2012. The overall survival (OS) probabilities of the GPS subgroups were estimated using the Kaplan–Meier method and were compared using the log-rank test. The prognostic significance of the GPS and the a-GPS was assessed by the Cox proportional hazards model with clinicopathological variables and inflammation markers, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). The GPS was calculated based on cut-off values of 1.0 mg/dl for CRP and 3.5 g/dl for Alb, as previously reported. The a-GPS was calculated based on cut-off values 0.3 mg/dl for CRP and 3.9 g/dl for Alb, which are the standard thresholds used by our institution. RESULTS: The GPS and the a-GPS were correlated with preoperative factors, such as age, sex, smoking status, the NLR and the PLR, and oncological factors, including the pathological stage, histological type and level of lymphovascular invasion. The 5-year OS rates were 82, 55 and 55% with GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.66), respectively, and 88, 67 and 59% with a-GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.04), respectively. Multivariable analysis revealed that the GPS [1 vs 0, hazard ratio (HR): 1.63, 2 vs 0, HR: 1.44] and the a-GPS (1 vs 0, HR: 2.00, 2 vs 0, HR: 2.10) were independent prognostic factors. The a-GPS classification showed a clearer prognostic distribution than the GPS classification. CONCLUSIONS: The GPS is a useful prognostic indicator of the OS in lung cancer surgery. The optimal cut-off values for GPS estimation may need to be re-evaluated. Keywords: Inflammation • C-reactive protein • Albumin • Lung neoplasms • Surgery • Risk factors
INTRODUCTION The Glasgow Prognostic Score (GPS) is an inflammation-based score that is widely accepted as a prognostic indicator in various types of cancer such as colorectal cancer, oesophageal cancer, gastric cancer, hepatocellular carcinoma and other types of cancers [1]. However, in lung cancer, most reports using the GPS focus on advanced-stage
† Presented at the 23rd European Conference on General Thoracic Surgery, Lisbon, Portugal, 31 May–3 June 2015.
disease [1–5]. This issue prompted us to evaluate the GPS as a prognostic indicator in operable-stage lung cancer. In addition, there is another issue regarding the thresholds of the GPS. The GPS was originally established with standard thresholds [>1.0 mg/dl for C-reactive protein (CRP) and
